The President of Chile and the WHO Director-General launch global Commission to tackle the "causes behind the causes of ill-health"

18 March 2005 | SANTIAGO/GENEVA/LONDON -Today, the President of the Republic of Chile, His Excellency Mr Ricardo Lagos Escobar and World Health Organization Director-General, Dr LEE Jong-wook launched the Commission on Social Determinants of Health, a new body to spearhead action on the social causes behind ill-health.

The new Commission includes leading global experts on health, education, housing and economics. Commissioners will work to recommend the best ways to address health's social determinants and safeguard the health of poor and marginalized populations, and to break the "poverty equals ill-health' cycle.

"Social standing plays a big part in whether people will live to be 40 or 80, whether they will be treated for a curable disease, and whether their children survive their fifth birthday. People should not die young because they are poor. This commission will assist countries, no matter how rich or poor, to implement strategies that will help people who are poor and marginalized live longer, healthier lives," said Dr Lee at the official launch in Santiago, Chile. "This effectively places the needs of the disadvantaged first on the health agenda in the 21st century."

Social determinants are the conditions in which people live and work. They are the "causes behind the causes" of ill-health. They include poverty, social exclusion, inappropriate housing, shortcomings in safeguarding early childhood development, unsafe employment conditions, and lack of quality health systems.

The core of the Commission's work will be to identify, evaluate, adapt and distribute effective strategies to address social determinants, with the aim of supporting governments to scale-up interventions. The Commission will operate for three years from this month.

"A great share of health problems is attributable to social conditions, and this is why the poor carry the greatest burden of ill-health. On a global scale, we must ensure that health policies move beyond exclusively disease-focused solutions and include the social environment," said Commission Chair Michael Marmot. "I am honoured to be working with Commissioners of such a high calibre. We will arm policymakers with the best evidence to ensure that poverty does not sentence a person to a shorter, unhealthy life."

Social determinants are intrinsically linked to inequities in health. They help to explain why poor and marginalized people get sick and die sooner than people in better social positions. They are a significant reason behind the world's vast difference in average life expectancy, which ranges from 34 years in Sierra Leone (lowest in the world) to 81.9 in Japan (highest in the world). Social determinants also account for the majority of health inequities within countries. In Indonesia, under-five mortality is nearly four times higher in the poorest fifth of the population than in the richest fifth. In England and Wales, the latest data shows a 7.4 year gap in life expectancy between men in professional occupations and men in unskilled manual occupations (1997-1999 figures).

Some countries—such as Chile, Sweden, and the United Kingdom—are already advancing innovative health programmes that address social determinants through a comprehensive inter-sectoral approach. For instance, social welfare programmes with benefits conditional on children's school attendance, regular medical check-ups, and other health-promoting actions are helping to reverse the "poverty equals ill-health" trend. Health inequity assessments resulting in the declaration of "health action zones" and health promotion campaigns targeting disadvantaged people are also safeguarding the health of vulnerable groups.

The Commission will identify successful strategies now underway in countries. It will work with national authorities to determine ways to replicate success in other countries and settings. Whereas, to date, the greatest progress in tackling social determinants has occurred in high-income countries, the Commission will focus especially on identifying and promoting policies applicable in developing countries, where the adverse health effects of social determinants are greatest. Overcoming these social barriers represents a prime opportunity to reduce global health inequalities and ensure that health gains are sustainable over time.

The Commission will focus the attention of the world's top experts and researchers on specific social determinants such as urban settings, social exclusion, and employment conditions. These "Knowledge Networks" will push the limits of current information to better define the links between social determinants and health, particularly in developing countries.

The Commission on Social Determinants of Health will work with national authorities to incorporate social determinants approaches into efforts to meet the Millennium Development Goals (MDGs). The MDGs recognize the interdependence of health and other social conditions, and present an opportunity to promote health policies that tackle the social roots of unfair and avoidable human suffering.